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� �� . .., q�E�,..,,�� � . . ::. � M . . '��,. P� ��,q�h��G� 1 rf f <br /> q[ �f� E Si � <br /> i e 4A s Y A$��V�p. e�l� L�" [�' u};�°��S i t <br /> S <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> Water Closet � � Floor Drains <br /> Lavatory � � Sewer Ejector <br /> Bathtub ,� Laundry Tray <br /> Shower ,� Washer ,� <br /> Kitchen Sink ,� Water Heater <br /> Disposal ,� Water Softener <br /> Dishwasher ,� Wet Bar <br /> Sillcocks Miscellaneous <br /> _ . � � <br /> ,� � • � �� ���: . � � �� i p a �w �;�, r ,�. <br /> � ...!� 1 p„ � fu�'d�5 4 f ; <br /> 5 pp����k[�L � � <br /> r�i � �" . , 1�����!"��5�AY.pz,.0 li'{ <br /> : <br /> ke d �a . � �. s�-" . '_ � ,. .. ,.. ,� .r. . .. .. <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or applianc at meets all three of the following require s: <br /> 1. Does not require modification to electrical or gas ice. /' <br /> 2. Has a total cost of$500.00 or less;excludine the cost the fixture or ap 'ance:and <br /> 3. Is improved,installed or replaced by the homeowner or nsed cont tor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surchazge $ 5.00 <br /> Mail-In Fee Applicable) $ 2.00 <br /> Total Per �t Fee $ <br /> ,. <br /> � <br /> '' '`'�, <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />